Hospitalist, Physician Advisor
Company: CommonSpirit Health
Location: Houston
Posted on: July 18, 2025
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Job Description:
Job Description Responsibilities This is a remote position and
you must be licensed in the state of Texas. As the Utilization
Management Physician Advisor (PA), the PA conducts clinical case
reviews referred by case management staff and/or other health care
professionals to meet regulatory requirements and, in accordance
with the hospitals objectives for providing quality patient care,
to assure effective and efficient utilization of health care
services. The PA communicates remotely with case and utilization
management to discuss selected cases and make recommendations
regarding level of care, as well as, communicates remotely with
medical staff members and medical directors of third-party payers
to discuss the needs of patients and options/alternatives for care.
The PA acts as a consultant to, and resource for, attending
physicians regarding their decisions relative to appropriateness of
hospitalization, appropriate level of care for initial
hospitalization and continued stay days, clinical documentation,
and use of healthcare resources. The PA further acts as a resource
for the medical staff regarding federal and state utilization and
quality regulations. The PA must demonstrate interpersonal and
communication skills and must be clear, concise and consistent in
the message to all constituents. Key Responsibilities - Conducts
medical record review in appropriate cases for medical necessity of
hospital admission, continued hospital stays, adequacy of discharge
planning and quality care management. - Understand the intricacies
of the Medicare Inpatient Prospective Payment System (IPPS) to make
medical determinations on severity of illness, acuity, risk of
mortality, and communicate with treating physicians in cooperation
with the utilization team and health information staff. -
Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and
APR-DRG. - Contacts Case and Utilization Management Teams: Makes
telephonic/electronic contacts with case and utilization management
to discuss clinical aspects of hospital encounters, as well as,
medical necessity and appropriate levels of care. - Contacts
Attending Physicians: Makes telephonic/electronic contacts with
Attending Physicians to discuss clinical aspects of hospital
encounters, as well as, medical necessity and appropriate levels of
care. Discussion may also include education for improved clinical
documentation, in addition to, governmental and commercial
guidelines for reimbursement. - Conducts Peer to Peer discussions
with payers as needed. Qualifications - MD or DO required -
Unrestricted license in field of practice in the state of Texas
required. - Minimum of 1 year of experience as a Physician Advisor
preferred. - Minimum of 5 years of clinical practice required. -
Experience performing Peer to Peer Reviews, preferred - Broad-based
knowledge regarding clinical practice. - Broad knowledge base with
trust and respect of medical staff physicians. - In-depth knowledge
of CMS regulations, including understanding of the 2-midnight rule.
- Utilization management experience. - Education in quality and
utilization management through continuing medical education
programs and self-study. - Knowledge of and practical use of good
business English, spelling, arithmetic, practices and the ability
to communicate effectively using written and verbal skills. LI-CSH
LI-Remote Overview Inspired by faith. Driven by innovation. Powered
by humankindness. CommonSpirit Health is building a healthier
future for all through its integrated health services. As one of
the nations largest nonprofit Catholic healthcare organizations,
CommonSpirit Health delivers more than 20 million patient
encounters annually through more than 2,300 clinics, care sites and
137 hospital-based locations, in addition to its home-based
services and virtual care offerings. CommonSpirit has more than
157,000 employees, 45,000 nurses and 25,000 physicians and advanced
practice providers across 24 states and contributes more than $4.2
billion annually in charity care, community benefits and
unreimbursed government programs. Together with our patients,
physicians, partners, and communities, we are creating a more just,
equitable, and innovative healthcare delivery system. Pay Range
$79.24 - $114.89 /hour
Keywords: CommonSpirit Health, Pasadena , Hospitalist, Physician Advisor, Healthcare , Houston, Texas
